Nowrosjee Wadia Maternity Hospital

Transcription

1 6. UNSAFE ABORTIONS The family planning programme of India is targeting towards providing a wide range of contraceptive choices to eligible couples with the ultimate objective of decreasing the unwanted pregnancies. Efforts in the direction of introduction of emergency contraception and injectables to the women in need are being intensified. The four decades old liberal MTP act, even today has not succeeded in decreasing the unsafe abortions which account for per cent of preventable maternal mortality. The increasing trend of abortions remains a serious health problem. Unmet need, increase in sexual activity among adolescents and youth, prenatal sex determination, inadequate health care facilities pose challenges in tackling the problem. Reducing the unmet need, addressing the issues of the adolescents and making abortion services accessible to women at an affordable cost will decrease unsafe abortions to a large extent. The institute is focusing its research activities on: (i) investigating women s knowledge/attitude and the need towards contraception and abortion; (ii) evaluating safe and effective medical methods for termination of pregnancy. 6.1 Contraceptive Knowledge and Practices of Women Requesting Medical Termination of Pregnancy Lalita S. Savardekar Duration: Shalini Baji,, U. Iddya and D. Balaiah Vandana Walvekar Nowrosjee Wadia Maternity Hospital To study the contraceptive knowledge, attitude and practices of women requesting medical termination of pregnancy (MTP) and to identify the determinants of unwanted or mistimed pregnancy, a study has been initiated by enrolling 740 women seeking abortion at an urban hospital: Nowrosjee Wadia Maternity Hospital. Details of the subject characteristics, type of family planning (FP) methods used: current and past, reasons for nonuse and failure of the methods have been previously reported (Annual Report , p.79). MTP was considered as a FP measure by 2.5 per cent of women. In depth interview revealed that two women had come for MTP after confirming that it was a female fetus on ultrasonography (Annual Report , p.79). Although over 90 per cent of women were aware of Cu-T, CoCs and condoms and 42 per cent aware of withdrawal, Cu-T, condoms and withdrawal were used only by 29 per cent, 47 per cent and 77 per cent respectively. Women discontinued 109

2 either Cu-T, CoC, Condom or rhythm method (11%) due to lack of strong motivation, incorrect knowledge and myths. It was observed that in spite of experiencing failure with condom /withdrawal, the couple preferred using the same since they were devoid of ill health effects. Unwanted pregnancies would have been prevented in 16 per cent of the women who were suitable candidates for emergency contraception (failure of withdrawal/condom) but were not aware of this backup method. Detailed information about who should use family planning methods, how/ when to use it, method failure, different types/brands available, return of fertility, their perceptions about linkage of method with STDs/RTIs were also obtained. Women were asked to enumerate the side effects and long term implications, if any with the different methods. A grading was assigned: (1-3 points) as some knowledge, (4-7) moderate knowledge and (8-10) complete knowledge, to a total of 10 points. Though per cent of women could only name the modern methods like CuT, CoC, Condom (heard), they were unaware of any other information. Proportionately large number of women had moderate knowledge of withdrawal and condom and some knowledge of tubectomy, vasectomy, CoC and Cu-T. Women had incorrect information regarding intake of pills while some didn t feel it necessary to undergo a regular follow up after IUD insertion (Table 10). Among the different methods, myths were frequently spelt out for Cu-T (41.5%) such as, IUD may cause cancer of the uterus, copper may rust and hence women expressed their fears of conception in future. Although 20 per cent of the women had a past history of an induced abortion, they were not aware of all the side effects and complications of MTP (Table 11). The study results stress the need for imparting complete information to the eligible couples for an increased and sustained use of effective methods. Counseling regarding correct use, treatable side effects, failure rate and clearing the myths of each method are essential to decrease the unwanted pregnancies. Further data analysis is ongoing. 110

3 Table 10: Awareness, knowledge, myths of family planning methods among abortion seekers (n=200). Knowledge Method Aware- Heard Some Moderate Complete Incorrect Myths ness % % % % % % % Cu T CoC Condom Withdrawal Rhythm Injectable Spermicide TL Vasectomy *Awareness = Heard + some knowledge + moderate knowledge + complete knowledge Table 11: Awareness of side effects and complications of MTP. Side effect /Complication % of women aware Bleeding 18.5 Pain 19.0 Infection 08.0 Incomplete abortion 12.0 Uterine perforation 10.0 Organ injury 04.0 Infertility 12.0 Mortality

4 6.2 Strategies to prevent unsafe abortions A Double Blind Randomized Comparison of Two Misoprostol Regimens for Termination of Pregnancy in the Second Trimester (WHO Multicentre Study) Anita Peddawad, Kavita Tilwani, Bhagyashree Kanje and Ruhi Pednekar A prospective randomized double blind placebo controlled trial comparing vaginal and sublingual regimens of misoprostol in the termination of pregnancies of weeks duration in 42 women has been undertaken. The women are allocated randomly to receive the active drug i.e. 0.4 mg misoprostol administered either vaginally or sublingually every 3 h up to five doses. Side effects are being recorded 3-hourly during the stay at the hospital and the outcome assessed 24 h (and 48 h, if needed) after the start of the treatment. The study was initiated in November 2002 and 19 cases have so far been enrolled Comparison of Two Routes and Two Intervals of Administration of Misoprostol for the Termination of Early Pregnancy: A Randomized Multicentre Trial (WHO Multicentre Study) Anita Peddawad, Kavita Tilwani, Bhagyashree Kanje and Ruhi Pednekar This prospective randomized double blind trial attempts to investigate the feasibility of the misoprostol only regimen with reference to acceptability, complete in 188 women abortion rate and the side-effects among pregnant women with a gestational age up to 63 days. The women are allocated randomly to receive three sublingual or vaginal doses of 0.8 mg of misoprostol either at 3 h or 12 h intervals. Side effects are recorded at 1 h and 3 h after misoprostol administration, and also after the last dose. The study was initiated in November 2002 and 46 cases have been enrolled to date. 112

5 6.2.3 Pretreatment with Misoprostol Before Vacuum Aspiration for First Trimester Induced Abortion: A Multicentre, Double-blind Randomized Controlled Trial Lalita Savardekar, Anita Peddawad, Kavita Tilwani, Bhagyashree Kanje and Ruhi Pednekar This is a multicentre double blind clinical trial of misoprostol administered 3 hours prior to surgical abortion by vacuum aspiration in the first trimester of pregnancy. The objective of the study is to evaluate if vaginal administration of misoprostol facilitates cervical dilation and reduces complications of first trimester induced abortion. The study will recruit 356 women in a one year period. The women will receive either active tablets (0.4 mg misoprostol) or placebo prior to surgical vacuum aspiration. The study will be initiated in April The women will be followed from admission, through the abortion procedure until a scheduled visit that will take place 5 to 10 days after the abortion. 113